Pericarditis

Introduction

Pericarditis is an inflammation of the pericardium, which may arise from viral, bacterial, fungal or protozoal infections
Other causes of pericarditis include: metabolic, malignancy, connective tissue disease, radiation, trauma etc
Pericarditis may be acute or chronic

Clinical features

Acute pericarditis:

  • Chest pain
    • Retrosternal
    • Sharp
    • Radiating to the left shoulder
    • Made worse by breathing or coughing
    • Relieved by the upright position
  • Low-grade fever
  • Pericardial friction rub

Chronic pericarditis:

Insidious onset
There may be:

  • Dyspnoea on exertion
  • Leg and abdominal swelling

Differential diagnoses

  • Endomyocardial fibrosis
  • Sarcodosis
  • Amyloidosis

Complications

  • Pericardial tamponade
  • Constrictive pericarditis

Investigations

  • Electrocardiography
  • Full Blood Count and differentials
  • Chest radiograph
  • Echocardiography

Treatment objectives

  • Relieve distress from pain and tamponade
  • Relieve constriction
  • Treat the effect on the heart
  • Treat complications
  • Eradicate the organism (if cause is infection)

Non-drug treatment

  • Bed rest

Drug treatment

NSAIDs

  • Indomthaem 50 mg orally every 8 hours

Or:

  • Ibuprofen 400-800 mg orally every 12 hours

Steroids

  • Prednisolone 30 mg orally every 8 hours and tapered

Anti-tuberculous drugs or other
antimicrobial agents (if mycobacterium
or other microbes are causative)

Supportive measures

  • Pericardiocentesis.
  • Pericardiectomy

Notable adverse drug reactions

  • NSAIDs/steroids: dyspepsia and upper GI bleeding

Prevention

  • Avoid radiation
  • Prevent infection.